Critical care medicine
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Critical care medicine · Oct 1989
Childhood near-drowning: is cardiopulmonary resuscitation always indicated?
The case histories of 93 consecutive pediatric near-drowning victims admitted to All Children's Hospital from 1983 to 1987 were retrospectively reviewed for patient status on ED arrival and eventual outcome. Age, sex, length of submersion, core temperature, pHa, absence of spontaneous respiration, lack of response to pain, and pupillary nonreactivity were all found to be unreliable predictors of outcome. ⋯ The use of cardiotonic medicines to establish a perfusing cardiac rhythm in the initial resuscitation was associated with an eventual outcome of severe neurologic damage or death in all instances. The decision to use cardiotonic medicines in the resuscitation of pediatric near-drowning victims should be weighed carefully against their ultimate chances of intact survival.
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The French emergency medical system (EMS) is the Service d'Aide Médicale Urgente (SAMU). In case of mass casualties, involving 100 simultaneous victims, SAMU has developed a disaster plan, "The White Plan." This plan is closely correlated to the Red Plan of the Fire Department, to provide advanced life support (ALS) at the incident site, followed in a continuum by medical transport and hospitalization in the appropriate services. ⋯ This objective was approached by adopting a formal protocol designed for each city. In France, the medical organization for the treatment of casualties is operated by anesthesiologists who are qualified to perform ALS, preanesthetic evaluation en route, anesthesia for the multitrauma patient, and postanesthetic resuscitation in a continuum from the accident scene to the ICU.